The school nurse called Johnny’s mom because he has been crying that his stomach hurts and he can’t go potty for 2 hours

The school nurse called Johnny’s mom because he has been crying that his stomach hurts and he can’t go potty for 2 hours. He doesn’t want to go back to school and doesn’t want to lie down and rest. His vital signs are normal. Mom took him to an urgent care because it is unlike Johnny to cry or to be constipated. She knows that he had a BM yesterday. She thinks something is wrong. After an exam, the urgent care sent him to the emergency room with a diagnosis of “high index of suspicion for appendicitis.” By the time he arrived at the ER, he was feeling less pain but was stating that he really had to have a bowel movement. He tried again for the 4th time that day, but could not defecate. The nurses took him immediately to a room and took his vitals. He had a temperature of 102.2 and his pulse was 115. Within one hour of arriving to the ER, Johnny was in the operating room.

What do you think the UC NP found on physical exam that made her suspect appendicitis?

Is Johnny constipated? If yes, why wasn’t that treated first. If no, what was causing him to feel that way?